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Zhu B, Zhou P, Chen Y, Cai C, Li Q. Surgical removal of an inferior vena cava filter in the duodenum: A rare case report and literature review. Heliyon 2024; 10:e33246. [PMID: 39040419 PMCID: PMC11261037 DOI: 10.1016/j.heliyon.2024.e33246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Background Inferior vena cava filters are typically retrieved using endovascular procedures. However, in cases where complications related to the filter arise or when endovascular retrieval becomes challenging, open surgery could be considered. Case presentation A 65-year-old woman underwent inferior vena cava filter placement surgery for progressive venous thrombosis embolism (VTE). Following an unsuccessful endovascular retrieval attempt at an external hospital two months later, she experienced abdominal pain and was transferred to our facility for further treatment. Examination revealed that she was encountered a complication where the inferior vena cava filter penetrated both the vena cava and the duodenum post-implantation. But fortunately, the patient's blood test results were within normal range. Ultimately, our institution successfully removed the filter through open surgery and the patient was discharged without any complications. Conclusions This case, along with our literature review, illustrates the viability and safety of duodenal-penetrated filter removal via open surgery, resulting in favorable outcomes and a promising prognosis for the patient.
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Affiliation(s)
- Bingjie Zhu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Peng Zhou
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yunfei Chen
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chuanqi Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qin Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Hicks AC, Sangroula D, Dwivedi AJ, Wayne EJ, Sigdel A. Inferior vena cava perforation during percutaneous filter removal. Vascular 2024; 32:190-194. [PMID: 36269323 DOI: 10.1177/17085381221135268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous Inferior Venacava (IVC) filter retrieval can be challenging when the filter is grossly angulated, embedded in the wall or penetrates through the IVC. When conventional filter removal technique fails, the use of advanced retrieval techniques often improves the chances of percutaneous filter retrieval. These techniques, however, are associated with a high rate of complications. METHODS We report a case of 26-year-old female who had IVC filter placed on postpartum day 4. Attempted percutaneous filter retrieval 3 weeks later with loop snare technique and endobronchial forceps assisted filter removal technique resulted in gross filter deformity, malposition, and IVC perforation. RESULT Open IVC filter removal was performed with midline laparotomy and cavotomy with lateral venorrhapy. The deformed filter along with adherent thrombus was completely removed. The patient had an uneventful recovery with no immediate or long-term complications. CONCLUSION Use of advanced endovascular IVC filter retrieval techniques could result in serious complications like filter fracture, migration and IVC perforation. Since excessive tilt of the filter at the time of placement often results in difficult retrieval, it is important to ensure proper deployment of the filter with minimal tilt. If encountered with excessively tilted or embedded filter, one should refrain from excessive manipulation of the filter and consider open filter removal.
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3
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Sheahan KP, Tong E, Lee MJ. A review of inferior vena cava filters. Br J Radiol 2023; 96:20211125. [PMID: 35856774 PMCID: PMC10997026 DOI: 10.1259/bjr.20211125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/20/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.
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Affiliation(s)
| | - Emma Tong
- Department of Radiology, Beaumont Hospital,
Dublin, Ireland
| | - Michael J. Lee
- Department of Radiology, Beaumont Hospital,
Dublin, Ireland
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4
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Tian X, Liu J, Li J, Jia W, Jiang P, Cheng Z, Zhang Y, Liu X, Zhou MI, Tian C. Removal of inferior vena cava filter by open surgery after failure of endovenous retrieval. Front Cardiovasc Med 2023; 10:1127886. [PMID: 37139130 PMCID: PMC10150111 DOI: 10.3389/fcvm.2023.1127886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background The permanent placement of inferior vena cava (IVC) filters may lead to numerous complications and their removal is recommended once the risk of pulmonary embolism is reduced. Removal of IVC filters by endovenous means is preferred. But failure of endovenous removal happens when recycling hooks penetrate the vein wall and filters are left in place for too long time. In these scenarios, open surgery may be effective for removal of IVC filters. We aimed to describe the surgical approach, outcomes, and 6-month follow-up of the removal of IVC filter by open surgery, after the failure of removal via the endovenous method. Methods A total of 1,285 patients with retrievable IVC filters were admitted from July 2019 to June 2021, including 1,176 (91.5%) endovenous filter removals, and 24 (1.9%) open surgical IVC filter removals after the failure by endovenous method, of whom 21 (1.6%) were followed-up and eligible for analysis of the study. Patient characteristics, filter type, filter removal rate, IVC patency rate, and complications were retrospectively analyzed. Results Twenty-one patients were left with IVC filters for 26 (10, 37) months, of which 17 (81.0%) patients had non-conical filters and 4 (19.0%) had conical filters; all 21 filters were successfully removed, with a 100% removal rate, no deaths, no serious complications, and no symptomatic pulmonary embolism. At the 3rd month follow-up after surgery and 3rd month follow-up after discontinuation of anticoagulation therapy, only 1 case (4.8%) had IVC occlusion, but without any occurrence of new lower limb deep venous thrombosis and silent pulmonary embolism. Conclusion Open surgery can be used for the removal of IVC filters after failure of removal by endovenous method or when accompanied by complications without symptoms of pulmonary embolism. Open surgical approach can be used as an adjunctive clinical intervention for the removal of such filters.
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5
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Fujimori K, Okada A, Tabata H, Shoda M, Kuwahara K. Percutaneous Removal of a Displaced Inferior Vena Cava Filter Using a Loop-Wire Technique and Lead-Extraction Sheaths. Circ J 2021; 85:1403. [PMID: 34039833 DOI: 10.1253/circj.cj-21-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koki Fujimori
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine.,Department of Cardiology, Tokyo Women's Medical University
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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6
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Lee J, Roche-Nagle G. Permanent IVC filter strut penetration into an abdominal aortic aneurysm. BMJ Case Rep 2021; 14:14/6/e241962. [PMID: 34099449 DOI: 10.1136/bcr-2021-241962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 85-year-old man with a known history of abdominal aortic aneurysm (AAA) presented to a vascular surgery clinic with a severely swollen, tender and erythematous left leg. An urgent CT angiogram demonstrated a left-sided, proximal deep vein thrombosis, and a permanent, Bird's Nest inferior vena cava (IVC) filter (Cook, Inc., Bloomington, Ind.) penetrating his AAA. The patient was treated with a course of apixaban 5 mg two times per day and the decision was made to closely observe his IVC filter and AAA, given his numerous comorbidities and age. This case highlights the unique considerations associated with an approach to permanent IVC filter complications among patients with AAAs.
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Affiliation(s)
- Juehea Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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7
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Ivanics T, Williams P, Nasser H, Leonard-Murali S, Schwartz S, Lin JC. Contemporary management of chronic indwelling inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2020; 9:163-169. [PMID: 32721588 DOI: 10.1016/j.jvsv.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite increasing retrieval rates of the inferior vena cava (IVC) filter, less than one-third are removed within the recommended timeline. Prolonged filter dwell times may increase the technical difficulty of retrieval and filter-related complications. We sought to evaluate the contemporary outcomes of patients with chronic indwelling IVC filters at a tertiary care center. METHODS A retrospective analysis was performed from August 2015 through August 2019 of all patients who were referred for removal of a prolonged IVC filter with a dwell time >1 year. Descriptive analysis was used to evaluate patients' characteristics and procedural outcomes, which were reviewed through electronic medical records. Data were expressed as median with interquartile range (IQR) or number and percentage, as appropriate. RESULTS A total of 47 patients were identified with a median filter dwell time of 10.0 years (IQR, 6-13 years); 34 patients underwent IVC filter removal, and 13 patients refused retrieval. The median age of patients was 54.9 years (IQR, 42.5-64.0 years); the majority were female (57%) and white (53%). The most common indication for filter placement was high risk despite anticoagulation (49%), followed by venous thromboembolism prophylaxis (21%). The majority of patients were symptomatic (72%). If symptomatic, the most common reason for retrieval was IVC penetration (94%), and the chief complaint was pain (56%). Retrieval success was 97%, with a median length of stay of 0 days. The majority of retrievals were performed through an endovascular approach (97%). There was one postprocedural complication (3%). CONCLUSIONS Despite prolonged dwell times, IVC filter retrieval can be performed safely and effectively in carefully selected patients at a tertiary referral center.
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Affiliation(s)
- Tommy Ivanics
- Department of Surgery, Henry Ford Hospital, Detroit, Mich.
| | - Paul Williams
- Vascular and Interventional Radiology, Department of Radiology, Henry Ford Hospital, Detroit, Mich
| | - Hassan Nasser
- Department of Surgery, Henry Ford Hospital, Detroit, Mich
| | | | - Scott Schwartz
- Vascular and Interventional Radiology, Department of Radiology, Henry Ford Hospital, Detroit, Mich
| | - Judith C Lin
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Mich
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8
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Mozgovoĭ PV, Ziubina EN, Spiridonov EG, Vorob'ev AA, Mandrikov VV, Zharkin FN, Lukovskova AA, Ufimtsev VS. [Total laparoscopic retrieval of a cava filter: case series]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:149-154. [PMID: 33332317 DOI: 10.33529/angio2020422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.
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Affiliation(s)
- P V Mozgovoĭ
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - E N Ziubina
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - E G Spiridonov
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - A A Vorob'ev
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - V V Mandrikov
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - F N Zharkin
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - A A Lukovskova
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
| | - V S Ufimtsev
- Clinic #1, Volgograd State Medical University of the RF Ministry of Public Health, Volgograd, Russia
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Chassin-Trubert L, Prouse G, Ozdemir BA, Lounes Y, Alonso W, Clapiès M, Alric P, Canaud L. Filter-Associated Inferior Vena Cava Thrombosis with Duodenal Perforation: Case Report and Literature Review. Ann Vasc Surg 2019; 58:383.e1-383.e6. [DOI: 10.1016/j.avsg.2018.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 12/01/2022]
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10
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ACR Appropriateness Criteria® Radiologic Management of Venous Thromboembolism-Inferior Vena Cava Filters. J Am Coll Radiol 2019; 16:S214-S226. [DOI: 10.1016/j.jacr.2019.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/02/2023]
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11
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Manzur M, Ochoa C, Ham SW, Lee W, Simcox T, Rowe V, Weaver F. Surgical Management of Perforated Inferior Vena Cava Filters. Ann Vasc Surg 2017; 42:25-31. [DOI: 10.1016/j.avsg.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/12/2016] [Accepted: 11/21/2016] [Indexed: 12/01/2022]
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12
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Indications and Outcomes of Open Inferior Vena Cava Filter Removal. Ann Vasc Surg 2017; 46:205.e5-205.e11. [PMID: 28602896 DOI: 10.1016/j.avsg.2017.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite recommendations for retrieval of inferior vena cava (IVC) filters, most are not removed in a timely manner. Longer IVC filter dwell times are associated with caval wall perforation and tilting that make percutaneous retrieval more difficult. Open IVC filter removal is generally reserved for patients with symptoms referable to the filter, such as chronic back and abdominal pain. We present our management algorithm and review of cases of open IVC filter removal. METHODS Patients referred for management of implanted IVC filters from May 2010 to May 2016 were included. Demographic and imaging were reviewed for cases requiring open surgical removal. RESULTS There were 221 percutaneous retrieval attempts in 218 patients. Successful retrieval occurred in 196 (89%) attempts. There were 7 patients who had open surgical IVC filter removal after failure of percutaneous retrieval. One patient had 2 filters and another had 3 filters. Except for 1 case with complications during the percutaneous retrieval procedure, the remaining patients all suffered from back or abdominal pain. All had significant filter strut penetration through the caval wall into adjacent structures. Postoperatively, all patients had relief of pain. There were no deaths and 1 patient had a minor ileus that spontaneously resolved. CONCLUSIONS Patients who fail percutaneous IVC filter retrieval can expect low morbidity and prompt resolution of symptoms after open surgical removal via minilaparotomy.
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13
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Delozier A, Ghaleb M, Andrade A. Tine after tine: a varied approach to the removal of a long-standing IVC filter. Radiol Case Rep 2017; 12:335-339. [PMID: 28491183 PMCID: PMC5417753 DOI: 10.1016/j.radcr.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/11/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022] Open
Abstract
Inferior vena cava filters are important tools used to help prevent life-threatening pulmonary embolisms in hospitalized patients with contraindications to pharmacological prophylactic anticoagulation. This is a case report of a patient who had an inferior vena cava filter placed after a traumatic subdural hematoma. He made a complete recovery but was lost to follow-up until he presented 1825 days after filter deployment with abdominal pain discovered to be from penetration of the filter tines outside the lumen and into adjacent structures. We describe a case complicated by fibrotic tine entrapment with penetration to surrounding structures and discuss the technical approach used to free and eventually remove the long-standing filter.
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Affiliation(s)
- Andrew Delozier
- Department of Medical Education, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Melhem Ghaleb
- Department of Radiology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Alonso Andrade
- Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
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14
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Davila VJ, Velazco CS, Stone WM, Fowl RJ, Abdul-Muhsin HM, Castle EP, Money SR. Robotic inferior vena cava surgery. J Vasc Surg Venous Lymphat Disord 2017; 5:194-199. [DOI: 10.1016/j.jvsv.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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15
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Large vein reconstructions in the endovascular era. PHLEBOLOGIE 2017. [DOI: 10.12687/phleb2351-1-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryMax Ratschow was a remarkable physician and an international authority in the field of angiology and the Ratschow lectureship helps to fulfill this pioneer’s life purpose: to advance evaluation and treatment of vascular diseases. The 2017 Max Ratschow lecture covers some recent advances and controversies in venous diseases. Phlebology, once a neglected field of angiology, is a discipline that has been in constant progress during the past decades. Endovascular techniques revolutionized treatment of patients with large vein obstruction and provided safe, minimally invasive procedures with excellent long term results. Attention now need to focus on comparative studies to provide scientific evidence of efficacy of venous angioplasty and stenting with properly organized randomized controlled trials. Further attempts are needed to develop special venous stents and to decrease thrombotic complications and formation of pseudointima that cause in-stent restenosis. Open and hybrid reconstructions are safe and durable, but the number of procedures in general is small and special training and expertise for reconstructive venous surgery is recommended. Autologous vein should be used for infrainguinal reconstructions and for treatment of unilateral iliac vein obstruction with a femoro-femoral cross-over bypass (Palma procedure). IVC and iliac vein reconstructions with ePTFE grafts provide superb result in patients who need excision of malignant tumors invading large veins. Open and hybrid reconstructions are here to stay and they remain excellent options for those patients who are unsuitable for or fail endovascular repair.
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Husainy MA, Daneshi M, Fang C, Yusuf GT, Ramnarine R, Wilkins CJ, Huang D. Spondylodiscitis and Iliopsoas Abscess after Inferior Vena Cava Filter Placement. J Vasc Interv Radiol 2016; 27:1730-1732. [PMID: 27926400 DOI: 10.1016/j.jvir.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Mohammad Ali Husainy
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mohammad Daneshi
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Cheng Fang
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - G T Yusuf
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Raymond Ramnarine
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - C J Wilkins
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Dean Huang
- Department of Radiology, King's College Hospital National Health Service Trust, Denmark Hill, London SE5 9RS, United Kingdom
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17
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Kuyumcu G, Walker TG. Inferior vena cava filter retrievals, standard and novel techniques. Cardiovasc Diagn Ther 2016; 6:642-650. [PMID: 28123984 DOI: 10.21037/cdt.2016.09.07] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The placement of an inferior vena cava (IVC) filter is a well-established management strategy for patients with venous thromboembolism (VTE) disease in whom anticoagulant therapy is either contraindicated or has failed. IVC filters may also be placed for VTE prophylaxis in certain circumstances. There has been a tremendous growth in placement of retrievable IVC filters in the past decade yet the majority of the devices are not removed. Unretrieved IVC filters have several well-known complications that increase in frequency as the filter dwell time increases. These complications include caval wall penetration, filter fracture or migration, caval thrombosis and an increased risk for lower extremity deep vein thrombosis (DVT). Difficulty is sometimes encountered when attempting to retrieve indwelling filters, mainly because of either abnormal filter positioning or endothelization of filter components that are in contact with the IVC wall, thereby causing the filter to become embedded. The length of time that a filter remains indwelling also impacts the retrieval rate, as increased dwell times are associated with more difficult retrievals. Several techniques for difficult retrievals have been described in the medical literature. These techniques range from modifications of standard retrieval techniques to much more complex interventions. Complications related to complex retrievals are more common than those associated with standard retrieval techniques. The risks of complex filter retrievals should be compared with those of life-long anticoagulation associated with an unretrieved filter, and should be individualized. This article summarizes current techniques for IVC filter retrieval from a clinical point of view, with an emphasis on advanced retrieval techniques.
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Affiliation(s)
- Gokhan Kuyumcu
- Cleveland Clinic Imaging Institute, Cleveland, OH 44195, USA
| | - T Gregory Walker
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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